BayCare, United Showdown Exposes Cost Disputes to the Public

The high-stakes showdown between Tampa Bay's biggest hospital system and one of its largest health insurers has exposed an unusual airing of medical prices, and who really foots the bill.

By LETITIA STEINTampa Bay Times

The high-stakes showdown between Tampa Bay's biggest hospital system and one of its largest health insurers has exposed an unusual airing of medical prices, and who really foots the bill.

The feud between BayCare Health System and UnitedHealthcare has thrown thousands of patients into limbo as they wait to see if they can agree by Monday, when the current contract ends. Neither side appears optimistic.

In a system that long has shielded the real cost of care from insured patients — who customarily only knew about premiums and co-pays — United is appealing directly to consumers by publicizing what it says BayCare is demanding for key procedures.

In full-page newspaper ads, United says BayCare is requesting as much as a 22 percent increase for employer plans, which translates to these whopping hikes:

• Hip replacement surgery would increase $12,000.

• Breast biopsy would increase $5,500.

• Cardiac catheterizations would increase $4,000 to $5,000.

"UnitedHealthcare has long had a commitment to driving greater transparency in health care," spokeswoman Elizabeth Calzadilla-Fiallo said in an email. "If we want to reduce the continued rise in health care costs and support more informed decisions, then individual consumers need to know how much their health care actually costs."

BayCare president and CEO Steve Mason called the figures "inaccurate and misleading," saying United has violated confidentiality agreements, which he cited in declining to comment further.

"This is a discussion between United and BayCare," said Mason, noting that the hospital system seeks only "fair pricing."

"To try to involve the community in a strategy where they are not getting the full picture is very confusing and misleading — and it's very unfortunate that they took that position."

Yet in letters to patients, BayCare declared it was owed more than $11 million in unpaid bills by United. Its full-page newspaper ads have listed names and phone numbers of Medicare Advantage plans seniors leaving United might consider.

In all, more than 400,000 United customers in the region, whether insured through commercial markets or the government-funded Medicare and Medicaid programs, could become collateral damage.

"It's just not fair," said Carol White, a United Medicare Advantage customer who must decide between changing doctors or finding another insurance provider.

The 69-year-old St. Petersburg woman was especially irked to receive a letter from BayCare outlining insurance alternatives with less than a month remaining to select her Medicare benefits for the coming year. "It was not thinking of the senior citizens," she said of the short notice. "That is what bothers me."

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While the public nature of the fight is surprising, such standoffs could become more common, said Alwyn Cassil, spokeswoman for the nonpartisan Center for Studying Health System Change.

Payment increases demanded by big systems like BayCare have been driving rising costs of health care, she explained. With alarm growing among employers who ultimately pass the hikes onto their workers, insurers may be reaching a breaking point.

"The stage is set for growing possibilities of these types of contract showdowns," Cassil said. "We saw a lot of this a decade ago, and it seemed that both the providers and the insurers had learned their lesson that riling up and creating anxiety for patients and enrollees was a lose-lose situation.

"But perhaps those lessons have been forgotten," she added.

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In 2002, a similar showdown led to three-month contract lapse between BlueCross BlueShield of Florida and BayCare, whose not-for-profit system includes St. Anthony's, St. Joseph's and the Morton Plant Mease hospitals.

The latest dispute dates to May, when negotiations over several lines of business, including Medicare Advantage and employer group accounts, took a wrong turn.

This week, United began blocking BayCare physicians from adding new Medicare Advantage patients to their practices, BayCare officials said. (Existing Medicare Advantage patients can continue seeing BayCare doctors, although they may have to change hospitals.)

"We can do something about negotiating for a fair contract," Mason said, "But unfortunately we can't do much about their strategic decision to get between the real sacred relationship here — the relationship between the physician and the patient."

Yet United contends that BayCare is throwing its weight around unreasonably. In its latest ad, it says that conceding would mean asking "local residents and businesses to pay millions more for their health care."

United says it spends about $330 million annually with BayCare — and the rate increases the hospital system is requesting would total more than a $50 million bump by the end of 2013.

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Without a deal before Monday, BayCare patients with United insurance can expect a confusing array of contingency plans. But all can continue to access BayCare's emergency rooms, which remain open under federal law.

United says patients who are in the middle of a course of treatment may be eligible to keep using a BayCare hospital with in-network benefits. Members are urged to call the number on the back of their cards, since details vary by plan. Even if it breaks with the area's biggest hospital chain on Monday, United notes that it has contracts with nearly 11,600 physicians in the region and all of the 21 other general hospitals.

BayCare officials say they will continue to admit United patients in nonemergency situations but will require prior authorization from United.

"We're going to try to mitigate everything that we can," said BayCare's Mason.